首页 » 工具箱 » Sample Forms » Benefits » COBRA: Termination of coverage due to lack of prem
文件名: COBRA: Termination of coverage due to lack of prem
文件大小: 28 KB
文件语言版本: English
文件类型:
Word
文件说明: Dear [COBRA beneficiary name],

According to our records, you elected COBRA continuation coverage beginning [date]. As stated on the election form you submitted (copy enclosed), you are required to make periodic payments in full for each COBRA coverage period. Although these periodic payments are due on the first day of the month for that month’s coverage, you have a grace period of 30 days after the day of the coverage period to make the payment. Your continuation coverage is provided for each coverage period as long as payment is made before the end of the grace period. If you fail to make a periodic payment before the end of the grace period for that coverage period, you will lose all rights to continuation coverage under the plan.
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